Provider Demographics
NPI:1548511215
Name:NEEDLEMAN, STACEY L (LCSW)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:NEEDLEMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 COUDERT PL
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-1014
Mailing Address - Country:US
Mailing Address - Phone:201-575-0078
Mailing Address - Fax:
Practice Address - Street 1:489 COUDERT PL
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-1014
Practice Address - Country:US
Practice Address - Phone:201-575-0078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052141001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical